The rural challenges of speech therapy |

Physical, occupational and speech language therapy may all be needed to help a patient recover from a debilitating illness, but finding a speech therapist can be difficult in a rural setting.

Megan Pass, the rehabilitation manager at Blue Mountain Hospital in John Day, said most larger hospitals provide all three disciplines, but rural hospitals are often too small to efficiently employ a speech therapist, a specialist who treats a variety of communication and swallowing problems.

“Usually, in rural hospitals, we will have mostly physical therapy, maybe an occupational therapist, and it is really questionable to have a speech therapist,” Pass said. “In urban communities, it is a service that is available.”

Since last summer, Grant County’s 7,200 residents have had access to all three disciplines at the small hospital, and the speech language therapy program has been so successful the hospital recently expanded its hours of operation.

The need

Pass, who was a traveling physical therapist and now resides in John Day, said speech language therapy is a significant medical service for the area.

Although mobility problems preventing a patient from walking or going to the bathroom are of immediate concern requiring rehabilitation departments to employ them first, she said, communication and swallowing problems can be serious.

“While that’s the reason why there aren’t that many (speech language pathologists) rurally, that’s also the reason why they’re needed,” she said. “The thing about speech is, if there is a swallowing issue and it goes unnoticed, it can lead to pneumonia and some big medical complications.”

A speech therapist treats a variety of communication and swallowing problems, including speech, language, communication, cognition, feeding and swallowing, Charissa Moulton, a speech language pathologist at the hospital, said.

Moulton said problems with speech often require more investigation than physical problems, which are typically apparent. She said speech problems are more often overlooked.

Before the hospital began its speech therapy program, Grant County residents could utilize inpatient speech therapy options in Burns, about an hour away, but only if the procedure required being admitted to the hospital because it did not offer outpatient speech therapy. To receive outpatient speech therapy outside of the school setting, patients traveled several hours to Bend, Pendleton or Boise.

The challenges

Moulton said rural speech therapy presents different challenges.

Speech therapy comprises a variety of functions, she said, and as the only all-ages provider in the county, she must focus on all of them.

“You can’t specialize as much,” Moulton said. “You have to do more because you’re serving everybody. In an urban place, you can specialize in just voice therapy, and that’s all the patients you would see.” 

Moulton said it requires a lot of learning and re-learning. She said it’s important to reach out to other speech therapists to talk about their experiences and to learn from each other.

“That’s the exact key to any profession rurally but especially speech (therapy), as you’re the only one in the building,” Pass said. “… It takes a very special person that’s willing to continually learn and improve. That’s what leads to excellent care.”

Overcoming COVID-19 complications sidebar

Speech language therapy has been especially impacted by COVID-19.

Speech therapists treat a variety of communication and swallowing problems, but the coronavirus pandemic has presented a major barrier: face masks.

Blue Mountain Hospital speech language pathologist Charissa Moulton said visual cues are important when diagnosing and treating speech problems, and the masks make it difficult.

“Working with the older population who may have hearing impairment and need those visual cues, it’s so much work trying to do a swallowing evaluation,” Moulton said. “I want them to copy what I’m doing, but they can’t see what I’m doing. For me, this has been the biggest challenge with meeting patients’ needs and being safe as well.”

Megan Pass, the rehabilitation manager at the hospital, said infants learn by mimicking, but face masks remove a speech language pathologist’s ability to treat patients through their innate ability to learn this way.

To overcome the difficulty, Moulton has been trying different types and brands of masks with clear panels so her mouth is visible to the patient. The hospital is also installing a Plexiglass barrier to keep the provider and patient separate in an outpatient setting.

Pass said another option is telehealth, where a patient completes a virtual visit online from home.

Despite the difficulties, she said, the hospital will always find a way to get patients the treatment they need safely.

“Being rural, you are very flexible and adaptable,” she said. “That is a quality that is required of any rural health care worker, no matter what your discipline is.”